Dataset Information

Adherence to the Women's Preventive Services Guidelines in the Affordable Care Act.

ABSTRACT: OBJECTIVE:To assess the adherence of women's health providers in New Mexico to the Women's Preventive Services Guidelines and to examine how providers' knowledge, attitudes, and external barriers are associated with adherence. DESIGN:Cross-sectional, descriptive survey. SETTING:New Mexico. PARTICIPANTS:Women's health providers in New Mexico, including nurse practitioners, certified nurse-midwives, and family practice and obstetrician-gynecologist physicians. METHODS:Participants completed a self-administered survey to measure knowledge, attitudes, external barriers, and adherence to each of the eight guidelines. Adherence was defined as following a guideline more than 90% of the time. RESULTS:The response rate was 22% (399/1,798). Among the eight guidelines, participant adherence ranged from 17.2% to 88.4%. Only 39.7% of participants indicated adherence to most of the guidelines (four or more). Overall, provider adherence was directly associated with familiarity with the guidelines (odds ratio = 3.69; 95% confidence interval [1.96, 6.96]), self-efficacy to implement them (odds ratio = 4.25; 95% confidence interval [2.21, 8.20]), and younger age (odds ratio = 0.97; 95% confidence interval [0.94, 1.00]). CONCLUSION:Adherence to the Women's Preventive Services Guidelines by providers in New Mexico is variable and, for many recommended practices, less than optimal. New targeted implementation strategies are needed to address barriers to adherence.

SUBMITTER: Tinkle MB

PROVIDER: S-EPMC5198580 | biostudies-literature | 2016 Nov - Dec

REPOSITORIES: biostudies-literature

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Adherence to the Women's Preventive Services Guidelines in the Affordable Care Act.

Tinkle Mindy B MB Tigges Beth B BB Boursaw Blake B McFarlane Deborah R DR

Journal of obstetric, gynecologic, and neonatal nursing : JOGNN 20160909 6

<h4>Objective</h4>To assess the adherence of women's health providers in New Mexico to the Women's Preventive Services Guidelines and to examine how providers' knowledge, attitudes, and external barriers are associated with adherence.<h4>Design</h4>Cross-sectional, descriptive survey.<h4>Setting</h4>New Mexico.<h4>Participants</h4>Women's health providers in New Mexico, including nurse practitioners, certified nurse-midwives, and family practice and obstetrician-gynecologist physicians.<h4>Metho ...[more]

PMID: 27615503

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Project description:PurposeHealth insurance coverage affects a patient's ability to access optimal care, the percentage of insured patients on a clinic's panel has an impact on the clinic's ability to provide needed health care services, and there are racial and ethnic disparities in coverage in the United States. Thus, we aimed to assess changes in insurance coverage at community health center (CHC) visits after the Patient Protection and Affordable Care Act (ACA) Medicaid expansion by race and ethnicity.MethodsWe undertook a retrospective, observational study of visit payment type for CHC patients aged 19 to 64 years. We used electronic health record data from 10 states that expanded Medicaid and 6 states that did not, 359 CHCs, and 870,319 patients with more than 4 million visits. Our analyses included difference-in-difference (DD) and difference-in-difference-in-difference (DDD) estimates via generalized estimating equation models. The primary outcome was health insurance type at each visit (Medicaid-insured, uninsured, or privately insured).ResultsAfter the ACA was implemented, uninsured visit rates decreased for all racial and ethnic groups. Hispanic patients experienced the greatest increases in Medicaid-insured visit rates after ACA implementation in expansion states (rate ratio [RR] = 1.77; 95% CI, 1.56-2.02) and the largest gains in privately insured visit rates in nonexpansion states (RR = 3.63; 95% CI, 2.73-4.83). In expansion states, non-Hispanic white patients had twice the magnitude of decrease in uninsured visits compared with Hispanic patients (DD = 2.03; 95% CI, 1.53-2.70), and this relative change was more than 2 times greater in expansion states compared with nonexpansion states (DDD = 2.06; 95% CI, 1.52-2.78).ConclusionThe lower rates of uninsured visits for all racial and ethnic groups after ACA implementation suggest progress in expanding coverage to CHC patients; this progress, however, was not uniform when comparing expansion with nonexpansion states and among all racial and ethnic minority subgroups. These findings suggest the need for continued and more equitable insurance expansion efforts to eliminate health insurance disparities.

Dataset Information

Adherence to the Women's Preventive Services Guidelines in the Affordable Care Act.

Publications

Adherence to the Women's Preventive Services Guidelines in the Affordable Care Act.

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